Alison Galbraith, MD, MPH, is a pediatrician committed to a research career investigating how health insurance policies affect health and health care at the population level for vulnerable groups of children. A K23 award will build upon a strong foundation of prior training and research, and provide necessary advanced education and experience through a multidisciplinary team of expert mentors and advisors and the outstanding resources of Harvard University. Valuable research experience will be gained in the process of studying how children's health and health care are affected by important trends in health policy - namely, the general trend toward increased use of cost-sharing and specifically, the introduction of high-deductible health plans (HDHPs). In recent years, health insurance plans have increased enrollee co-payments and deductibles in response to escalating health care costs. Scant information is available on how the health of children and the experiences of their families are affected by current approaches that increase families' sharing in health care costs. The proposed research will examine the experiences of children and families in HDHPs through a complementary set of studies from several perspectives, with the following Specific Aims: 1) to evaluate the child and family-level clinical and demographic characteristics that predict enrollment in HDHPs compared to traditional plans; 2) to examine how children's enrollment in HDHPs affects use of important health care services relative to traditional plans, matching for propensity to enroll in HDHPs; and 3) to pilot a survey of parents to describe the impact of HDHPs from the perspective of the child's family, particularly on unmet health care needs, financial burden, and family health care decision making strategies. The applicant's unique environment in a department jointly sponsored by Harvard Medical School and Harvard Pilgrim Health Care provides the opportunity to collect information about the health of children in HDHPs and other plans through multiple sources, including claims data and surveys of enrollees. The proposed studies, coursework, and mentorship will help develop and apply new skills in advanced analytic techniques and assessment of children's health care needs and outcomes. The research and training of the proposed award will enable Dr. Galbraith to become an independent investigator in population-based child health policy research, with the ultimate goal of informing policy to improve the health of vulnerable children. [unreadable] [unreadable] [unreadable]